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[Treatment] Nearly eliminated OAs, but getting tons of consecutive CAs?
#1
No-prescription newbie trying to optimize settings. Would love some advice!
Hi everyone! I’m new to this board. My name is Max and I’m 23 years old. Currently living in Los Angeles, but I’m from Norcal, in the Sacramento area. 

I heard this was the go-to place for getting help with analyzing OSCAR data. I’m one of those weirdos that has never had an official medical diagnosis, but I was struggling with symptoms for so long that I bought my own machine and decided to try fixing it on my own asap. I may have the opportunity to schedule a study in the next 6-12 months (Still on parents’ insurance but I moved outside of the provider’s locale, so no non-emergency services are available).

I only started using OSCAR for the past two nights, and had just started successfully sleeping with my machine and using MyAir for a couple of nights before that. I started wide open (pressure 4-20) and due to AHI readings of 8-10 from MyAir, I decided to bump the pressure up to 6 and then 10. The results seem to be better, but they are still confusing to me. I attached data from the two nights I’ve been using OSCAR, with an example of a (possible false positive?) CA.





Tonight, I’m going to turn EPR all the way off, and back my pressure down to around 9, to see if EPR (tweaked from 2 to 1) is correlated with the decreasing rate of CAs between Jan 22nd and 23rd, rather than the pressure.

My overall assessment is that I’m still a long way from optimizing my settings. From what I’ve read, the flow rate ought to be much less jagged and inconsistent than it has been these past two nights, right? I have heard that getting AHI to sub 1-2 can make a huge difference, and allow one to reach the level where the difference is day-and-night. So far, I’ve felt better, as of the past two nights, but only a little bit. Hoping I can find some serious relief my optimizing this thing, and of course getting used to the machine. The last two nights, I’ve (intentionally) taken off the mask when I woke up at the end of the recorded session, then decided I was more comfortable without the mask, and drift off to sleep again for a few hours before waking up and starting my day. I will try to resist the urge to take the mask off from here on!

Anyway, that’s about the full story. Would appreciate it if you guys have any more input! And of course let me know if you have any questions I should clarify!

TIA! Wishing you all the best.

Attachment for Jan 22nd. Was unable to attach more than one at a time. My apologies if I’m doing anything wrong.

Close-up of two CAs plus a hypopnea.


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#2
RE: No-prescription newbie trying to optimize settings. Would love some advice!
Welcome to AB.
The first CA in your zoomed image I believe resulted from the arousal/rough breathing preceding it and was likely you holding your breath. Also note the depth of your breathing prior to that. Look at the recovery of that, much deeper meaning more air exchange with more flushing of CO2 from your system. See how those larger breaths are tapering off? This may indicate a decreasing concentration of CO2 in your blood lessening your need to breathe as you approach your apneic threshold. The rough breathing may be related to the previous arousal. This is not enough data to be definitive about your apnea.

Central Apnea is consistently inconsistent, don't know why, it just is, it bounces all over the place. You are correct in that you want to reduce EPR to reduce central events.

Here's the catch. Your hypopneas and flow limits are best treated by increasing EPR which will also increase central Apnea. Yes this is a real balancing act.

The good news is that your Central Apnea will likely decrease over the next 2-3 months as your body gets used to breathing more efficiently.

This is too small as sample to say much definitively.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#3
RE: No-prescription newbie trying to optimize settings. Would love some advice!
Oh hi there! Your software is wonderful. Really appreciate anyone who makes such a great program free and open-source, Not to mention helping users with free advice. Thank you sir! 

As for the topic.. Very interesting. I was not aware that there was any benefit to EPR, aside from comfort for new users. It was a lifesaver for the first couple of nights, to realize I wasn’t stuck with such difficulty exhaling. But I’ve already become accustomed to it, and did a trial run watching TV with EPR off today. Don’t think it will be an issue tonight. 

Definitely seems like a balancing act. Makes me wonder about the validity of a doc’s prescription, and how often they’ll actually choose the optimal settings for the patient right off the bat. Assuming they would discourage patients from tinkering like I do, it seems like it would be a nightmare to coordinate, get permission to make tweaks, and finally reach a sub-2 AHI. I’m close already, but I still feel like I’m a month or two away.

I had never heard that the brain will acclimate to breathing with a CPAP. Really cool! I like the idea that this is an absolutely superior method of supplementing sleep. This cures my (very loud) snoring and chronic issue with mouth breathing and waking up with dry mouth/teeth. So even if my self-diagnosis is incorrect (I don’t believe it is), I am still better off with the machine, than without it. 

I’m just praying that I won’t regret not choosing a Bi-level machine. Researching this topic of CAs has led to me to realize that many people think they’re the hot ticket.


Thanks again!
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#4
RE: No-prescription newbie trying to optimize settings. Would love some advice!
The machine for CA is the ASV with a best cost of $1500-1600.
A BiLevel cannot treat CA.
Both CPAP and BiLevel maintain pressure, an ASV maintains volume and those algorithim are absent from CPAPs and BiLevels.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#5
RE: No-prescription newbie trying to optimize settings. Would love some advice!
CC, you have a terrific machine and a great attitude, so I'm confident you will make this work and start feeling better.

As Gideon has explained, that deeper breathing can wash out some CO2, which reduces your drive to breath for a bit, until the CO2 builds back up. The raggedy breathing is typical of a brief arousal, which is not necessarily a wake-up but might be. I know from my own experience that CAs can settle down with time, though you can always get a night with a surprise.

Also as Gideon mentioned, EPR can help reduce flow limitations and hypopneas -- RERAs too. The little pressure boost you get as you start inhaling is what makes the difference. A bilevel machine can provide a bigger boost, but there's no reason to think you need that.

Over all, I'd like to suggest that you stick with settings for at least a few nights. This is because sleep is fairly variable from one night to the next, and you want to be spotting trends, not one-offs. If you're comfortable with EPR of 1 or 0, pick one and see how it goes with your current minimum and maximum.

Keep us posted, would you?
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#6
Nearly eliminated OAs, but getting tons of consecutive CAs?
Have anyone seen something like this? My first week with the machine, and I've been encountering issues with CAs in particular. But a previous night with these settings resulted in 3.9 AHI. I am fairly certain I was asleep by the time the first flurry of them occurred. But regardless, there are other, similar instances of repeated CAs after the first group. Strangely, I expected the results to be good today, and woke up feeling more energized than usual.

Is this something that might improve with time and brain acclimation? I do not have a prescription, sorry! Have been titrating myself.

   


   
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#7
RE: Nearly eliminated OAs, but getting tons of consecutive CAs?
CactuaCactus,
I have merged your two threads, as it makes it's easier for those that respond to see what has already been advised. Thanks.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Nearly eliminated OAs, but getting tons of consecutive CAs?
(01-27-2021, 04:25 PM)OpalRose Wrote: CactuaCactus,
I have merged your two threads, as it makes it's easier for those that respond to see what has already been advised.  Thanks.

Thank you, sir! That makes sense. I will update in this thread from now on.
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#9
RE: Nearly eliminated OAs, but getting tons of consecutive CAs?
Let's turn off EPR / Set EPR=0 and see what happens/ Screenshots of this please and 3min zoomed shot as you have above.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#10
RE: Nearly eliminated OAs, but getting tons of consecutive CAs?
I'm supposing we're treating this as treatment emergent due to no sleep study data. As mentioned by Gideon, turning off EPR can give us some tells on how CA respond. I'm of the impression reducing/eliminating EPR should show reduction in CA pretty quickly if they're treatment emergent.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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